Using Antidepressants in Pregnancy

When considering treatments of depression in pregnant women, there needs to be consideration of risk due to depressive disorder to the mother and fetus, teratogenic risk to the fetus, and perinatal risks. There are effective medication treatments and non-medication treatments for depressive disorders. Discontinuation of antidepressant medication during pregnancy is associated with a high rate of depression relapse. The risk to mother and infant of not treating depression is substantial, both during pregnancy and post-partum. With regard to teratogenicity, there is experience with commonly used medications. SSRIs and SNRIs do not appear to increase the risk for major congenital anomalies, with the exception of paroxetine. A number of studies found increased risk of cardiac malformations with paroxetine, though this association remains controversial. There are also antidepressant medications from other classes that have been associated with congenital anomalies by some studies, including bupropion and clomipramine. With regard to perinatal risk, a neonatal adaptation syndrome has been estimated to occur in about one-third of deliveries. These adverse effects in infants tend to be mild and transient. It may be helpful to have mothers and infants remain in the hospital for two days post-delivery to ensure that the infant is healthy.

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